By Tom Philpott Military Update
After five years and an estimated $1 billion spent trying to build a single integrated electronic health record (iEHR) system with the Department of Veterans Affairs, defense health officials have been taken off the project, sources confirm.
Wielding the hook was Defense Secretary Chuck Hagel who signaled disappointment with his management team to a House panel this month, saying he halted a solicitation for bids from commercial electronic record designers because “I didn’t think we knew what the hell we were doing.”
A congressional source confirmed that DoD oversight for developing an interoperable electronic health records is now under Frank Kendall, under secretary of defense for acquisition, technology and logistics. The shift was first reported Monday by the news website NextGov.
A cloud of confusion descended on the VA-DoD effort to create a single e-record system after an awkward joint announcement in February by departing-Defense Secretary Leon Panetta and VA Secretary Eric Shinseki. Panetta suggested development of a single system had grown unaffordable and some “quick wins” were needed to show progress on seamless transfer of electronic medical files of veterans moving from military to VA care.
Rather than build a customized system “from scratch,” Panetta said, the VA would keep but improve its popular record system, Vista, and electronic military health data would gain interoperability with VA by deploying an existing commercial software solution “as quickly as possible.”
By summer, he said, DoD and VA would field a pilot program that would allow clinicians to share VA and DoD medical data at seven joint rehabilitation and poly-trauma centers treating veterans with the most serious wound. These facilities would have interoperable records by the end of July this year, Panetta promised.
What the two leaders actually were announcing, charged the chairmen and ranking members of the veterans affairs committees, was their failure to agree on a single record system after years of work and public promises.
They said this compromise wasn’t what Congress directed in 2008 nor was it what Barrack Obama had promised campaigning for president and in 2009 when announcing a joint DoD-VA effort to build a single virtual lifetime electronic record for veterans from enlistment to their death in old age.
Yet for weeks after the February announcement, VA and Defense leaders continued to insist the compromise was what had been promised. Key lawmakers, including Sen. Patty Murray (D-Wash.), now Senate budget committee chairman, and Rep. Jeff Miller (R-Fla.), House veterans affairs committee chairman, didn’t buy that claim nor, it turns out, did Hagel after he was briefed on the course change.
Architects of the compromise were Jonathan Woodson, assistant secretary of defense for health affairs, and Beth McGrath, deputy chief management officer for the department. Their plan to buy proprietary health records software from industry, however, was labeled as expensive and shortsighted by other technical experts inside the Pentagon.
The director of operational test and evaluation for DoD, J. Michael Gilmore, told Deputy Defense Secretary Ashton Carter in a March 28 memo that the “current approach is manifestly inconsistent with the President’s open standards agenda for electronic health records.”
While Obama wanted “a broad spectrum of government, industry and academic participants” involved in pursuit of an open standards iEHR, which would be less costly and easier to achieve, Gilmore charged that DoD actions throughout Obama’s first term had gone against the president’s agenda.
“The Department’s past and current desire is to completely replace its healthcare information technology package – Armed Forces Health Longitudinal Technology Application (AHLTA) – with an existing commercial healthcare management package,” Gilmore said.
This resistance to an open standard’s agenda, he continued, “appears to be founded largely on an incorrect assumption” that this “will take too much time and the lack of immediate progress will inevitably cause [DoD] to be forced to adopt the Vista software” used by VA. But an open standards agenda “has nothing whatsoever to do with the department using Vista.”
Gilmore urged a course shift. DoD should design and test an overall architecture of iEHR and then build or purchase software that would allow AHLTA “to interact with the outside world via open standards.”
Defense officials wouldn’t comment on reports that Woodson’s office had lost oversight responsibility for design of the integrated electronic health record. But a congressional source said key lawmakers have been told it had.
In his appearance April 16 before the House appropriations subcommittee on defense, Hagel promised he would announce a revised decision on the iEHR within 30 days, meaning mid-May.
“I can’t sit here and defend what we’ve done” over four years, Hagel told Rep. Nita M. Lowey (D-N.Y.) who blasted the lack of progress after DoD and VA had spent a billion dollars so far on integrating its health records.
“I could take you down through the programs and say ‘Well, it hasn’t been totally wasted because these things have come out of the investment.’ But I’m not going to do that. I am going to acknowledge that we are way behind. We will do better…I’m restructuring who’s in charge and the accountability of this. I deferred a request for proposal. I’ve stopped it from going out at the end of March…And until I get some understanding of this and get some control of it, we’re not going to spend any more money on it.”
Hagel said he understood lawmakers’ frustration, which is heightened by the growing backlog of compensation claims filed by veterans, slowed in part by health records that still must be transferred by hand.
“We have not completed an integrated health record system which was what we committed to,” Hagel said. Both the president and Congress still want “a seamless, interoperable system.”
Shinseki, meanwhile, is sounding more confident about VA’s decision to keep but modernize Vista. He told the Senate Budget Committee last week that Vista “is government owned, government operated and we have put Vista into the open architecture so that anyone else can use the code that goes with Vista and won’t have to pay for it.”
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